Reliability of the Radiographic Parameters in Pediatric Supracondylar Fracture

PURPOSE: To suggest the most reliable guideline of the treatement for the supracondylar fracture in children by the comparison of the radiographic parameters between forearm supination-elbow extension and forearm pronation-elbow flexion view. MATERIALS AND METHODS: A total of seventy-one patients were included in the study. Baumann, metaphyseal diaphyseal and medial epicondylar epiphyseal angle of normal elbow in extension and flexion view were compared. Finally, the results of Group I (operation with elbow extension view) and Group II (operation with elbow flexion view) were compared. RESULTS: Intraobserver reproducibility and interobserver reliability were better in the Baumann angle with extension view and metaphyseal diaphyseal angle with flexion view. In extension view, Baumann and metaphyseal diaphyseal angle show negative correlation with carrying angle but in flexion view, only metaphyseal diaphyseal angle shows negative correlation. Baumann angle were greater in flexion view and medial epicondylar epiphyseal angle were greater in extension view. There was no statistical difference in the final results of Group I and II. CONCLUSION: Baumann angle was more effective in forearm supination-elbow extension view and metaphyseal diaphyseal angle was more effective in forearm pronation-elbow flexion view. The difference between elbow extension and flexion view should be considered during operation.

Variability of Radiographic Measurements of Bowleg deformity in Children: A new method for Metaphyseal Diaphyseal Angle (MDA) / 대한정형외과학회잡지

PURPOSE: We investigate a new measurement method for bowleg deformity in children to reduce intra-observer and inter-observer error and to assess change in the angles measured with respect to the rotation of the lower leg. MATERIALS AND METHOD: Fifty-one children younger than 3 years old with bow leg were analyzed. To assess the intra-observer and inter-observer error of the Metaphyseal-Diaphyseal Angle, Intermetaphyseal-metaphyseal angle and Tibio-Femoral angle measurements, supine view antero-posterior radiographs of the lower legs were taken at the neutral rotation, at 10 degrees and at 20 degrees internal rotation positions. Also, the effect of the rotation of lower legs upon the measured angle was assessed by comparing and analyzing the angle values with respect to rotations of the lower leg. RESULTS: TInter-observer error showed statistically significant difference (p<0.05). All measured angles showed statistically significant differences with respect to the rotation of the lower legs. The measurement variability introduced by rotation was significantly greater than the intra-observer and inter-observer errors. The Intermetaphyseal-metaphyseal angle measurement had the lowest standard error and the highest correlation coefficient. CONCLUSION: The Intermetaphyseal-metaphyseal angle measurement seems a highly reliable method, which could be clinically utilized. Also, since the rotation of the lower legs influences the metaphyseal-diaphyseal angle, the clinician should consider this effect when studying a simple radiograph for bowleg deformity.

Comparartive Study of Metaphyseal / 대한정형외과학회잡지

Differential diagnosis between physiologic bow legs and nonphysiologic bow legs is difficult and still not fixed in diagnosis, especially under 5 years old age. Recently the problem exist in differential diagnosis and treatment method of rickets because of non-specific laberatory finding in rickets. Metaphyseal-Diaphyseal angle in distal femur, Diaphyseal-Diaphyseal angle between femur and tibia, and Metaphyseal-Diaphyseal angle in proximal and distal tibia, and Metaphyseal-Metaphyseal angle in tibia are measured and compared for 30 bow legs children. And divided into rickets group and physiologic bow legs group by clinical and laboratory findings. The results are as following 1. Mean age was 1.91 years old at initail examination, 2.08 years old in rickets group, 1.73 years old in phisiologic bow legs group. 2. Diaphyseal-Disphyseal angle between femur and tibia was 18.12 ±6.80 in rickets group. And 10.17±5.36 in phisiologic bow legs group. Metaphyseal-Diaphyseal angle in distal femur was 10.88±3.62 in rickets group. And 8.42±4.42 in physiologic bow group. 3. Metaphyseal-Diaphyseal angle in proximal tibia was 11.50±2.56 in rickets group. And 7.17±2.01 in phisiologic bow legs group. It's angle in distal tibia was 10.50±3.86 in the former and 9.50 ±3.09 in the later group. Metaphyseal-Metaphyseal angle in tibia was 20.68±3.91 in rickets group and 16.78±4.11 in phisiologic bow legs group. According to the above mentioned results. Metaphyseal-Metaphyseal angle and Metaphyseal- Diaphyseal angle in tibia are comparable to gross appearance of bow legs deformed children rater than Diaphyseal-Diaphysealangle between femur and tibia, and Metaphyseal-Diaphyseal angle in distal femur. All values are high in rchekts, statistically. Therfore measurement of above mentioned angle in simple X-ray is valuable in differential diagnosis between phisiologic bow legs and Rickets.

A Study of Tibio / 대한정형외과학회잡지

The object of this study was 336 Korean patients with degenerative arthritic knees and 1000 Koreans with normal knees who had visited the department of orthopaedic surgery of Hanyang University hospital during the period fmm January, 1980 to June, 1981. The purpose of this study was to investigate the changes of tibio-femoral angles and metaphysealdia physeal angles in response to the degenerative changes of the knees. By the roentgenogram, tibio-femoral angles and metaphyseal-diaphyseal angles were measured and those angles were analized statistically. The results were as follows 1. In young age group, the incidence of the degenerative arthritic knees was more frequent in male than in female. However, in the middle and older age groups, the incidence was higher in female than in male. 2. The mean value of tibio-femoral angle of the degenerative arthritic knees was −3.41°±0.22. It was about 1° varus compared with the normal mean value of −4.46°±0.27. The mean value of tibio-femoral angle in normal Korean was reduced appmximately 3°±5°valgus compared with the Westem normal peoples: 3. In general, the valgus tendency appeared a little more in the knees of female than in those of male. 4. The varus tendency was in pmportion to the degree of the aggrevation of the degenerative arthritis in the knees. 5. The mean value of metaphyseal-diaphyseal angle in normal Korean was 3.53°±0.24. It was 3°–4° varus compared with the Western normal peoples. 6.The varus was increased more in the standing position, in the state of weight bearing position, than in the supine position.